No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Children's and Adolescent's Views on Family Therapy
Abstract
Family therapy has made a considerable contribution to our understanding of the experiences of children and families and especially how various symptoms can be understood as their response to distressing family dynamics. Though family therapy has found ways of alleviating children’s distress we still know relatively little about how children experience the process of family therapy. Such knowledge is important for ethical as well as pragmatic reasons – to be able to offer a more sensitive and effective experience. This paper reports a study employing qualitative methods whereby children were interviewed about their experience of family therapy. Semi-structured interviews were conducted after family therapy sessions, and children were invited to recall what they perceived to be helpful and unhelpful. Helpful events or moments were then identified and replayed on the videotape of the sessions to assist children’s memory. The results suggest a diversity of experiences according to the children’s ages, gender and role in the family. Some common assumptions were challenged by the findings, for example, that some children preferred more directive and focused aspects of the therapy, rather than systemic questions which could inspire feelings of confusion and inadequacy.
... In family treatment, forming an alliance with children or adolescents might be even more complex, as they are less powerful interaction partners as compared to adults, and the presence of parents in sessions (even when in part) might cause feelings of shame and a hesitation to be open (Escudero & Friedlander , 2017). Although being heard during treatment appears to be very important for youths in family therapy (Strickland-Clark et al., 2000), playing an active role in a conjoint treatment process with adults is challenging for children and adolescents, and should therefore be carefully guided by the therapist both verbally and non-verbally (Escudero & Friedlander, 2017;O'Reilly, 2008). ...
... Thus, children and adolescents often expect treatment to be a correcting and coercive environment, resulting in defensive and mistrusting behavior (Escudero & Friedlander, 2017). The presence of parents in sessions, even though of crucial importance, may add to this mistrusting attitude in children and adolescents, since it may cause feelings of shame or fear of negative consequences after the treatment session (Escudero & Friedlander, 2017;Strickland-Clark et al., 2000). ...
... It should therefore be carefully guided by the therapist both verbally and non-verbally (Escudero & Friedlander, 2017;Moore & Bruna-Sue, 2011;O'Reilly, 2008;Strickland-Clark et al., 2000). ...
Home-based family treatment (HBFT) is the most provided service in youth care, serving families with complex child and parenting problems. Empirical evidence indicates varying outcomes of HBFT, and thus it is important to examine factors that may contribute to desirable outcomes. The current dissertation aimed at investigating such an important factor: the working alliance. The central aim was to investigate alliance processes in (home-based) family treatment in relation to outcome, paying particular attention to the therapists’ role and to the systemic complexity of building multiple interacting alliances with and within the family. The dissertation opens with a meta-analytic review of previous studies on the alliance-outcome association in family-involved treatment for youth problems. In the remaining chapters the working alliance is investigated from multiple perspectives, based on multi-informant questionnaire and observational data on alliances and treatment outcome in a Dutch HBFT for youth problems.
Findings underline the importance and complexity of building strong working alliances with families receiving (home-based) treatment. It indicates that clinical practice as well as education and training of providers of (home-based) family treatment may benefit from a focus on actively engaging family members in the treatment process and investing in strong emotional bonds. The findings also underscore the importance of a more systemic perspective on the working alliance both in research and practice. This includes addressing the process of building multiple interacting alliances with different family members, engaging children and adolescents in a conjoint treatment process with parents, and promoting the family’s collaboration on shared goals.
... Many children seem to appreciate therapy and have described it as helpful Carlberg et al., 2009;Day et al., 2006;Georgsson et al., 2007;Midgley et al., 2006). They value being listened to and being included in the therapy and appreciate a supportive professional relationship (Buston, 2002;Stith, Rosen, McCollum, Coleman, & Herman, 1996;Strickland-Clark, Campbell, & Dallos, 2000). Furthermore, children seem to prefer treatment that includes activities and the possibility of play (Day et al., 2006;Lobatto, 2002;Moore & Seu, 2011;Stith et al., 1996). ...
... They feel insecure about the reasons for and the purpose of therapy, as well as about the rules of the therapeutic sessions (Lobatto, 2002;Paul, Foreman, & Kent, 2000). Children have described being wounded by judgements and reprimands during the sessions, and some children have stated that therapy can be a painful experience of feeling overwhelmed and also not understood (Strickland-Clark et al., 2000). They have reported that therapy can make certain aspects of their life worse, including making them feel different in relation to peers, and some children wish not to take part (Carlberg et al., 2009;Midgley et al., 2006;Paul et al., 2000). ...
... The result that all children expressed positive experiences of participating in the group treatment was striking. The experience of joy was strongly anchored in all interviews, in contrast with previous studies describing some children having negative experiences of treatment (Buston, 2002;Carlberg et al., 2009;Midgley et al., 2006;Paul et al., 2000;Stith et al., 1996;Strickland-Clark et al., 2000). In this study, none of the children expressed not wanting to attend or feeling psychologically insufficient or alienated in relation to their peers. ...
Abstract
The risk of exposure to Intimate Partner Violence (IPV) between caregivers is increased during early childhood. The adverse effects on the health and development of the youngest children may be severe. Effective and promising interventions for children who have experienced IPV have been developed and evaluated. However, there is a lack in knowledge about how the children themselves experience the interventions. The aim of this study was to elucidate young children’s own experiences of participating in a group-treatment designed to improve their psychological health in the aftermath of family violence. Nine children, ages four to six, were interviewed after participating in group-programs specifically designed for children who have been exposed to intimate partner violence. A semi-structured interview guide with open-ended questions was used. The interviews were transcribed and analyzed using interpretative phenomenological analysis to ensure focus on the children’s own views and experiences. Five master themes embracing the children’s experiences were identified: Joy - positive emotional experience of participation; Security - feeling safe; Relatedness - relations within the group; To talk – externalized focus on the violence; and Competence – new knowledge and skills. Theoretical and clinical implications and the benefit of including very young children´s views and experiences in research are discussed.
... Research assessing children's experiences in family therapy also highlights their wishes to play a larger role in therapy. Strickland-Clark, Campbell, and Dallos (2000), for example, interviewed children, ages 11 to 17, after family therapy sessions at two clinics in England, finding that children want to be heard, accepted, and included in the family therapy sessions (Strickland-Clark et al., 2000). In a similar study, Stith, Rosen, McCollum, Coleman, and Herman (1996) interviewed 16 children at two family therapy clinics, ages 5 to 13, who had participated in family therapy sessions. ...
... Research assessing children's experiences in family therapy also highlights their wishes to play a larger role in therapy. Strickland-Clark, Campbell, and Dallos (2000), for example, interviewed children, ages 11 to 17, after family therapy sessions at two clinics in England, finding that children want to be heard, accepted, and included in the family therapy sessions (Strickland-Clark et al., 2000). In a similar study, Stith, Rosen, McCollum, Coleman, and Herman (1996) interviewed 16 children at two family therapy clinics, ages 5 to 13, who had participated in family therapy sessions. ...
... As described in Chapter 2, research has highlighted the importance of children playing an active role in treatment and therapy, listening to children, and involving them in decisions related to their treatment (J. Davies & Wright, 2008;Hepper et al., 2005;Laws, 1998;Moses & Kirk, 2005;Roth & Roth, 1984;Stith et al., 1996;Strickland-Clark et al., 2000). Here, I examine how participants in this study recall experiencing their treatments, and to what extent their voices were included in decisions about their care. ...
Despite increasing numbers of children diagnosed with mental health disorders, there is limited research on how children come to understand these diagnoses in childhood. Drawing on 42 in-depth, semi-structured interviews with emerging adults between the ages of 18 and 22 who were diagnosed with attention deficit hyperactivity disorder (ADHD), depression, generalized anxiety disorder (GAD), and/or bipolar disorder before the age of 17, this study examines how emerging adults recount making sense of their diagnoses in childhood. Interviews elicited participants??? life history narratives, including how they learned about, experienced, and discussed their diagnoses in childhood, and their recommendations for how diagnoses should best be delivered and explained to children.
Participants??? accounts suggest that parents play an instrumental role in delivering diagnoses to children, often acting as translators and withholders of information. Parental knowledge about children???s mental health affects children???s experiences, and withholding diagnoses can exacerbate stigma. Children actively seek and obtain additional information about their diagnoses as they make sense of them over time. Rather than simply absorbing information, children actively interpret, embrace, and challenge narratives from multiple sources throughout their childhoods. While diagnoses may empower children by providing an explanation for their symptoms, motivating them to make changes, and opening doors to treatment, children often experience and fear stigma associated with diagnoses and treatments as well.
This study demonstrates the importance of sharing information openly with children in developmentally appropriate ways. It underscores the importance of educating and supporting parents in the crucial role they play in this process. To help minimize stigma, participants suggest that adults share information simply but directly with children and provide assurances that diagnoses are common, not their fault, not a reflection of their intelligence, and legitimate. This study raises the question of whether there are ways to achieve the goals of providing explanations, legitimizing problems, and shifting blame away from individuals without stigmatizing, labeling, and pathologizing children???s conditions. By inviting children into the discussion, both in research and in practice, we can give voice to - and learn from - children???s experiences.
... Many children seem to appreciate therapy and have described it as helpful Carlberg et al., 2009;Day et al., 2006;Georgsson et al., 2007;Midgley et al., 2006). They value being listened to and being included in the therapy and appreciate a supportive professional relationship (Buston, 2002;Stith, Rosen, McCollum, Coleman, & Herman, 1996;Strickland-Clark, Campbell, & Dallos, 2000). Furthermore, children seem to prefer treatment that includes activities and the possibility of play (Day et al., 2006;Lobatto, 2002;Moore & Seu, 2011;Stith et al., 1996). ...
... They feel insecure about the reasons for and the purpose of therapy, as well as about the rules of the therapeutic sessions (Lobatto, 2002;Paul, Foreman, & Kent, 2000). Children have described being wounded by judgements and reprimands during the sessions, and some children have stated that therapy can be a painful experience of feeling overwhelmed and also not understood (Strickland-Clark et al., 2000). They have reported that therapy can make certain aspects of their life worse, including making them feel different in relation to peers, and some children wish not to take part (Carlberg et al., 2009;Midgley et al., 2006;Paul et al., 2000). ...
... The result that all children expressed positive experiences of participating in the group treatment was striking. The experience of joy was strongly anchored in all interviews, in contrast with previous studies describing some children having negative experiences of treatment (Buston, 2002;Carlberg et al., 2009;Midgley et al., 2006;Paul et al., 2000;Stith et al., 1996;Strickland-Clark et al., 2000). In this study, none of the children expressed not wanting to attend or feeling psychologically insufficient or alienated in relation to their peers. ...
The risk of exposure to intimate partner violence (IPV) between caregivers is increased during early childhood. The adverse effects on the health and development of the youngest children may be severe. Effective and promising interventions for children who have experienced IPV have been developed and evaluated. However, there is a lack in knowledge about how the children themselves experience the interventions. The aim of this study was to contribute to the evaluation of group treatment designed to improve the psychological health of young children in the aftermath of family violence by elucidating the children's experiences of participating. Nine children, aged 4 to 6 years, were interviewed after participating in group programmes specifically designed for children who have been exposed to intimate partner violence. A semi-structured interview guide with open-ended questions was used. The interviews were transcribed and analysed using interpretative phenomenological analysis, to ensure a focus on the children's own views and experiences. Five master themes embracing the children's experiences were identified: joy - positive emotional experience of participation; security - feeling safe; relatedness - relationships within the group; to talk - externalised focus on the violence; and competence - new knowledge and skills. Theoretical and clinical implications and the benefit of including very young children's views and experiences in research are discussed.
© The Author(s) 2014.
... Concerns have been raised however about the increase in the number of families dropping out of family therapy and failing to receive the services they need (Topham and Wampler 2008). Ostensibly a key focus for family therapy is to provide a forum through which the child's perspective can be aired (Strickland-Clark et al. 2000) but problematically children and adults have different levels of cognitive and linguistic competence and this creates a challenge for mutual exchange (Lobatto 2002). Lobatto argues that it is difficult therefore for the therapist to create an atmosphere which is inclusive of all parties as therapy tends to be predominantly adult led, and has potential to contribute to attrition rates. ...
... Research illustrates that children want to be included in therapy in a meaningful way (Stith et al. 1996) but the presence of their parents can inhibit their conversational contributions (Beitin 2008;Strickland-Clark et al. 2000). For example, children in family therapy speak less than their parents (Mas et al. 1985), are interrupted more frequently (O'Reilly 2008), and yet when interrupting are treated in negative ways (O'Reilly 2006). ...
... Although family therapists have developed strategies for engaging children in the therapeutic process we have a limited evidence base for how children experience therapy or how they engage with it (Strickland-Clark et al. 2000) or disengage from it. Analysis of the behaviour of children and families in therapy can be useful for predicting therapeutic outcomes (Kazdin et al. 2005). ...
Children’s engagement and disengagement, adherence and non-adherence, compliance and non-compliance in healthcare have important implications for services. In family therapy mere attendance to the appointments is no guarantee of engaging in the treatment process and as children are not the main initiators of attendance engaging them through the process can be a complex activity for professionals. Through a conversation analysis of naturally occurring family therapy sessions we explore the main discursive strategies that children employ in this context to passively and actively disengage from the therapeutic process and investigate how the therapists manage and attend to this. We note that children competently remove themselves from therapy through passive resistance, active disengagement, and by expressing their autonomy. Analysis reveals that siblings of the constructed ‘problem’ child are given greater liberty in involvement. We conclude by demonstrating how therapists manage the delicate endeavour of including all family members in the process and how engagement and re-engagement are essential for meeting goals and discuss broader implications for healthcare and other settings where children may disengage.
... Authors have noted the limited number of studies into young people's perspectives in family therapy research (Moore and Seu, 2011), despite the fact that family therapy is often conducted in relation to problems presented by children (Dallos and Draper, 2005). While a number of qualitative studies have attempted to redress this by exploring children's and young people's views of participating in family therapy (for example, Lobatto, 2002;Strickland-Clark et al., 2000), the MST literature remains lacking in its exploration of caregiver's and young people's experiences and perspectives. Lobatto (2002) and Strickland-Clark et al. (2000) employed grounded theory methodology (Glaser and Strauss, 1967) to explore children's and adolescent's experience of participating in family therapy. ...
... While a number of qualitative studies have attempted to redress this by exploring children's and young people's views of participating in family therapy (for example, Lobatto, 2002;Strickland-Clark et al., 2000), the MST literature remains lacking in its exploration of caregiver's and young people's experiences and perspectives. Lobatto (2002) and Strickland-Clark et al. (2000) employed grounded theory methodology (Glaser and Strauss, 1967) to explore children's and adolescent's experience of participating in family therapy. They have discussed how family therapy is experienced by young people and the factors influencing whether they felt heard and understood in the therapeutic process. ...
Multisystemic therapy (MST) is an empirically validated, family and community-based intervention for young people presenting with antisocial and offending behaviour. This qualitative study aimed to explore young people's experiences of MST and learn what had helped them to sustain positive outcomes over time. Semi-structured interviews were conducted with eight young people at an average of 14 months after MST (range: 5-21 months). A constructivist version of grounded theory was employed to analyse the data, leading to the development of a model of sustained change in MST. Themes from the model included therapeutic alliance, increases in systemic awareness, recognizing responsibility, positive peer relationships, acknowledging and celebrating success, continued use of specific strategies (for example, worry boxes) and the identification and creation of a preferred future. This research presents an understanding of how change may be sustained after MST, highlighting systemic, developmental and individual factors in relation to this. Clinical implications and a proposed model of sustained change in MST are discussed. Practitioner points • The therapeutic alliance was perceived by young people as central to the process of change and sustained change following MST • Young people's contribution to sustaining therapeutic gains at follow up, alongside caregivers, highlighted the importance of actively engaging them in therapy • Peer relationships were identified as relevant to sustaining change, particularly in relation to shared values and goals for the future Keywords: youth offending; qualitative research; child and adolescent mental health.
... Studies exploring children's experiences of family therapy conclude that children are active participants and able to reflect on their experiences, that they see therapy as a place to solve a problem, to make things better, and find solutions, but that they are also sensitive to judgment and reprimands and are sometimes insecure about the rules of family therapy (Lobatto, 2002;Moore & Seu, 2011;Stith, Rosen, McCollum, Coleman, & Herman, 1996;Strickland-Clark, Campbell, & Dallos, 2000). Stith et al. (1996) and Strickland-Clarke (2000) showed that children valued being listened to and included in therapy, but some also expressed that therapy could be painful, with overwhelming feelings and feelings of not being understood. ...
... Across studies, 5% to 10% of patients are shown to develop increased or new symptoms over the course of psychotherapy (Lambert, & Ogles, 2004;Lilienfeld, 2007). Research has repeatedly shown that some children report feeling bad or stigmatized, and a few may suffer from increased symptoms when taking part in interventions (Carlberg et al., 2009;Lobatto, 2002;Midgley et al., 2006;Stith et al., 1996;Strickland-Clark et al., 2000). None of the studies in this thesis indicated any increase in symptoms or distress in the children, which indicates that these two group interventions may be regarded as safe for both children and caregivers. ...
linnaeus university press Lnu.se ISBN: 978-91-88761-45-3 (print), 978-91-88761-46-0 (pdf) Exposure to violence toward a caregiver during childhood is associated with negative impact on children's health and development, and there is a need for effective interventions for these children. The diversity of experiences among children exposed to intimate partner violence includes a broad variety and complexity of child consequences and reactions that require a diversity of interventions and will result in a variety in outcomes. This calls for a highly reflective stance in research and in clinical practice. This thesis includes three empirical studies-all part of the same research project-with the general aim to augment knowledge about interventions for children exposed to intimate partner violence. Interviews with children and assessments of their mental health problems and trauma symptoms before and after the intervention were conducted to elucidate children's experiences of participating in two group interventions and of their relation to the abused parent, as well as the outcomes of interventions. The children showed competence and recovery as well as vulnerability. They experienced joy, learning, positive development, safe and nourishing relations, as well as fear, confusion, symptoms of distress, malfunctioning , and insecure relations. These simultaneous strengths and vulnerability of children require professionals to balance the important objectives of protection, provision, and participation.
... Whilst a number of qualitative studies have attempted to redress this by exploring children's and young people's views of participating in family therapy (e.g. Lobatto, 2002;Strickland-Clark et al., 2000), MST literature continues to lack in its exploration of caregiver's and young people's experiences and perspectives. ...
... These aforementioned qualitative studies (Lobatto, 2002;Strickland-Clark et al., 2000) employed grounded theory (GT) methodology (Glaser & Strauss, 1967) to explore children's and adolescent's experience of participating in family therapy. They highlighted how family therapy was experienced by young people and factors influencing whether they felt heard and understood in the therapeutic process. ...
Multisystemic therapy ( MST ) is an empirically validated, family and community‐based intervention for young people presenting with antisocial and offending behaviour. This qualitative study aimed to explore young people's experiences of MST and learn what had helped them to sustain positive outcomes over time. Semi‐structured interviews were conducted with eight young people at an average of 14 months after MST (range: 5–21 months). A constructivist version of grounded theory was employed to analyse the data, leading to the development of a model of sustained change in MST . Themes from the model included therapeutic alliance, increases in systemic awareness, recognizing responsibility, positive peer relationships, acknowledging and celebrating success, continued use of specific strategies (for example, worry boxes) and the identification and creation of a preferred future. This research presents an understanding of how change may be sustained after MST , highlighting systemic, developmental and individual factors in relation to this. Clinical implications and a proposed model of sustained change in MST are discussed.
Practitioner points
The therapeutic alliance was perceived by young people as central to the process of change and sustained change following MST
Young people's contribution to sustaining therapeutic gains at follow up, alongside caregivers, highlighted the importance of actively engaging them in therapy
Peer relationships were identified as relevant to sustaining change, particularly in relation to shared values and goals for the future
... JOURNAL OF MARITAL AND FAMILY THERAPY more open and personal sense (e.g., Kazdin, 1997Kazdin, , 2005Sprenkle et al., 2009;Tseliou et al., 2020), it is important that each family member's voice and experience is equally heard. However, only limited evidence has been gathered thus far on how children experience therapy (e.g., Moore & Seu, 2011;Strickland-Clark et al., 2000). The present small-scale study contributes to addressing this gap in the literature. ...
Applying Dialogical Methods for Investigations of Happening of Change (DIHC), this study investigated how children who had been diagnosed with an oppositional defiant or conduct disorder participated in a collaborative post-therapy research interview and talked about their experiences of family therapy. The results showed that the children participated as dia-logical partners talking in genuine, emotional, and reflective ways. Encountered as full-membership partners, the children also co-constructed meanings for their sensitive experiences. However, their verbal initiatives and responses appeared in very brief moments and could easily have been missed. The collaborative post-therapy interview offered a safe forum for co-reflection by participants on what they had found useful or difficult in the family therapy process. In this interview setting , the family first listens to reflection by the therapists on the therapy process and their thoughts on some of the fam-ily's related sensitive issues. The results indicate that when therapists present themselves as not-knowing, receptive and accountable, therapists may facilitate reflection for all family members, including children. K E Y W O R D S children, collaborative, family therapy, post-therapy research interview 2 | HELIMÄKI Et aL.
... According to Bakhtin, 'For the word there is nothing more terrible than a lack of response' (Bakhtin, 1975, p. 127). Although a key principle in family therapy is that children's perspectives are heard (Strickland-Clark et al., 2000), it is obvious that sessions are typically constructed by adult-led talk and conversation. To hear children's voices means engaging them as full members of the therapeutic dialogue, as participants who have important things to say. ...
As a multifaceted phenomenon, family secrets affect interaction in the therapeutic system. This qualitative study, applying the multi‐actor Dialogical Methods for Investigations of Happening of Change, explored how children participated and positioned themselves in family therapy in a climate of family secrets. The results showed that the children were active co‐participants in the complex dynamics of a secretive atmosphere, involving themselves in the paradoxical processes of reconstructing and deconstructing the secretive and unsafe climate. In family therapy, a child’s symptomatic behaviour can function as a visible ‘cover story’ for invisible constructions of secrets, preventing sensitive topics from becoming the focus of therapy. Family secrets therefore continue to present a challenge in family therapy practice and research.
Practitioner points
• Family secrets should be asked about in pre‐therapy assessment and diagnostic interviews where all family members are present
• The genogram enables the exploration of multigenerational family patterns and functions that might be influenced by family secrets
• By normalising the phenomenon of family secrets, therapists could make room for joint discussions on these and encourage family members to talk about their good reasons for keeping secrets
... Forming an alliance with children or youngsters is often difficult for family therapists. Qualitative psychotherapy research shows that children experience therapy as a challenge and that being heard is very important to them (Strickland-Clark, Campbell and Dallos, 2000). Furthermore, research suggests that, if the therapist does not specifically attempt to engage with children, children do not succeed in taking the conversational floor from an adult in a family therapy session (O'Reilly, 2008). ...
As research suggests that there is a strong link between the quality of the therapeutic alliance and the effectiveness of psychotherapy, family therapists should reflect on ways to improve the quality of the alliance. The systematic use of client feedback can be a rich resource as a response to the complexity of the alliance in the family therapy setting. In this paper the focus is on ways in which the client’s systematic feedback can contribute to an optimisation of the therapeutic alliance. We present the Dialogical Feedback Tool (DFT), a simple feedback instrument to be used especially in family therapy sessions in which young children are involved. A case study illustrates how the feedback of clients on their experiences in therapy can help therapists to better attune to family members' experiences and expectations about therapy.
Practitioner points
The therapeutic alliance in family therapy is complex, especially when children are involved
Using a simple feedback instrument can help deal with the complexity of the therapeutic alliance
The most important challenge for therapists using feedback instruments is how to integrate the feedback in a constructive way in the therapeutic process
... Having information about how children experience the therapeutic process, if that experience helped them to accomplish their objectives, what were the aspects of the intervention more valued and useful for them, what skills and strategies they have learned with that experience and whether they use those skills and strategies in their daily lives after therapy is terminated is important for ethical as well as pragmatic reasons, allowing to design more sensitive and effective interventions (Strickland-Clark, Campbell, & Dallos, 2000). Moreover, qualitative and exploratory studies about children's therapeutic experiences could provide valuable data about key elements of the therapeutic process, including factors promoting child´s motivation and adherence (Biering & Jensen, 2011), as well as knowledge about mediating variables that contribute to the effectiveness of treatment (Maric, Heyne, MacKinnon, van Widenfelt, & Westenberg, 2013). ...
Este estudio explora la recordación y perspectiva de los niños 9 meses después de su participación en un programa grupal cognitivo-conductual –el Programa Amigos para la Vida. Se realizaron entrevistas semiestructuradas a 26 niños (entre 9 a 13 años). Se han analizado: (1) los aspectos más recordados del programa; y (2) el nivel de comprensión de las estrategias y su uso después finalizarlo. Los resultados revelaron que los aspectos más recordados fueron sus objetivos, las actividades específicas y las estrategias aprendidas. Las dimensiones mencionadas como las más apreciadas fueron las actividades específicas y los aspectos relacionales. El aspecto considerado más importante fue la diminución de la ansiedad. Cuando se les preguntó directamente acerca de las habilidades aprendidas, ellos revelaron un mayor conocimiento y uso de estrategias relacionadas con la gestión somática de la ansiedad, el componente cognitivo y el componente de apoyo social. Se discuten las implicaciones de este estudio.
... Having information about how children experience the therapeutic process, if that experience helped them to accomplish their objectives, what were the aspects of the intervention more valued and useful for them, what skills and strategies they have learned with that experience and whether they use those skills and strategies in their daily lives after therapy is terminated is important for ethical as well as pragmatic reasons, allowing to design more sensitive and effective interventions (Strickland-Clark, Campbell, & Dallos, 2000). Moreover, qualitative and exploratory studies about children's therapeutic experiences could provide valuable data about key elements of the therapeutic process, including factors promoting child´s motivation and adherence (Biering & Jensen, 2011), as well as knowledge about mediating variables that contribute to the effectiveness of treatment (Maric, Heyne, MacKinnon, van Widenfelt, & Westenberg, 2013). ...
Abstract. This study explores the recollection and perspective of children nine months after their participation in a group cognitive-behavioral program for anxious children-the Friends for Life Program. Semi-structured interviews were applied to 26 children (9-13 years). We analyzed: (1) the most recalled aspects of the program; and (2) the comprehension level of the strategies and their use after the end of the program. Results revealed that the most remembered aspects of the program were its' goals, specific activities and strategies learned. The dimensions most appreciated by the children were the specific activities and relational aspects. The aspect considered most important was the decrease in anxiety. When questioned about the skills learned, they revealed a greater knowledge and use of strategies related to the somatic management of anxiety, the cognitive component and the social support component. Children were able to do a meaningfully evaluation of their experience with the CBT intervention.
... Having information about how children experience the therapeutic process, if that experience helped them to accomplish their objectives, what were the aspects of the intervention more valued and useful for them, what skills and strategies they have learned with that experience and whether they use those skills and strategies in their daily lives after therapy is terminated is important for ethical as well as pragmatic reasons, allowing to design more sensitive and effective interventions (Strickland-Clark, Campbell, & Dallos, 2000). Moreover, qualitative and exploratory studies about children's therapeutic experiences could provide valuable data about key elements of the therapeutic process, including factors promoting child´s motivation and adherence (Biering & Jensen, 2011), as well as knowledge about mediating variables that contribute to the effectiveness of treatment (Maric, Heyne, MacKinnon, van Widenfelt, & Westenberg, 2013). ...
This study explores the recollection and
perspective of children nine months after their
participation in a group cognitive-behavioral
program for anxious children –the Friends
for Life Program. Semi-structured interviews
were applied to 26 children (9-13 years). We
analyzed: (1) the most recalled aspects of the
program; and (2) the comprehension level of
the strategies and their use after the end of
the program. Results revealed that the most
remembered aspects of the program were
its’ goals, specific activities and strategies
learned. The dimensions most appreciated
by the children were the specific activities
and relational aspects. The aspect considered
most important was the decrease in anxiety.
When questioned about the skills learned,
they revealed a greater knowledge and use of
strategies related to the somatic management
of anxiety, the cognitive component and the
social support component. Children were
able to do a meaningfully evaluation of their
experience with the CBT intervention.
... In society, children and youth are seen as representing their parents and the quality of their family life (Schousboe, 2005;Wyness, 2000); consequently, there is a tendency to view young people's mental health issues as failures on the part of their caregivers and in their parenting (Hinshaw, 2005;Ryan, 2005). This tendency is considered to contribute to parent blaming (Fox, 2012;Ryan, 2005;Strickland-Clark, Campbell, & Dallos, 2000) and the negative valuing of some forms of family life over others. Theorizing about family life draws attention directly onto parents and specifically onto the types of parents, childhood experiences, and child-rearing contexts considered to support or interrupt "normal" development (Becker & McCloskey, 2002;Dearing, 2008;Ludwig & Mayer, 2006). ...
The aim of this article explores structural stigma in child and youth mental health. The focus is on the experiences of caregivers with children between 12 and 22 years old in their encounters with the systems involved with their families for their children’s mental health. The outcomes are presented of a study based on analysis of 10 transcripts—two focus group and eight interview transcripts—with 15 caregivers with children involved with mental health services. Two main themes emerged: (a) structural stigma as denigrating encounters within and across service systems (i.e., child and youth mental health, education, child protection, and criminal justice) and (b) fragmentation of the service delivery system as a significant factor exacerbating stigmatizing encounters. The implications for mental health practice with families are considered.
... Systemic family therapy has moved on from its early roots. These lie in the Milan School, the work ofPallazolli et al (1978)and (in the UK) in the pioneering contribution of the Family Institute Cardiff (Dowling et al,1982, Jones 1993) and the Tavistock London (Strickland et al 2000). Other important influences have come from the Palo Alto group, interactional communication theorists such asWatzlawick et al (1974), the schizophrenia family studies from the early 1990s (Leff 2000) and the London depression trial (Leff et al 2000).More recently, the later part of the 20 th century witnessed the evolution of the so called post-modernist therapies. ...
... While this first session is ostensibly parent focused, we argue that the child should be also afforded the opportunity to express themselves freely without their parents. This is particularly important as research has indicated that children find the presence of their parents inhibiting (Strickland-Clark, Campbell, & Dallos, 2000). Thus a session alone with the child could be beneficial, and this could take place concurrently with another member of the family therapy team. ...
In this chapter, we utilise a discourse perspective to explore ways in which parents manage therapeutic alignment in family therapy. As therapy is an activity which relies heavily on the use of language (McLeod, 2001), we use a language-based analytic approach to explore child mental health, particularly as discourse analysis is most appropriate for looking at family therapy processes (Roy-Chowdhury, 2003). In this chapter, we present a case for the deliberate temporary exclusion of children in the initial stages of a series of therapeutic sessions. The purpose of this temporary exclusion is to provide opportunities for therapists to engage in active solution-focused alignment with parents in order to provide a foundation and set boundaries for later work with the whole family. We also argue that while this initial session with parents is taking place, the child could be otherwise engaged in a session of their own so that the child’s perspective and expectations are also managed effectively.
... It is worth noting that, despite family therapy's commitment to systemic principles, children's involvement in family therapy is limited in practice (Miller & McLeod, 2001). There is relatively little research on children in family therapy and the majority of studies focus on children's experience of family therapy through individual or family interviews (Lobatto, 2002;Moore & Seu, 2011;Stith, Rosen, McCollum, Coleman, & Herman, 1996;Strickland-Clark, Campbell, & Dallos, 2000). This study assumes a different perspective and examines how family therapy with children is actually practiced, in line with the trend of language-based, constructionist research of psychotherapy process. ...
This paper aims to highlight the potential contribution of the arguments developed in Burman’s Deconstructing Developmental Psychology for exploring the implications of discourses around development for the practice of family therapy with children. Through the analysis of one brief systemic therapy with a stepfamily, formed following the mother’s death, this paper examined how discourses from developmental psychology, including representations of children, father, mother, stepmother and family, are implicated in the construction of the problem and in the positioning of the participants. The diverse ways in which the family members made sense of their difficulties and the positions they assumed were shown to be intimately linked with culturally dominant representations of the biological nuclear family ideal and with representations of parents as responsible for their children’s difficulties. The position of stepmother in particular was shown to be characterised by conflict and ambiguity, reflecting discourses that idealise motherhood and vilify stepmothers. Moreover, the children were found to be positioned as ‘half-members’ at several points in the conversation, whilst at other points they themselves resisted calls to a more equal positioning, particularly when disagreeing with the adults’ talk. Family therapy, as an institutional practice, was shown to be intimately linked with developmental psychology accounts about childhood, family life and parenthood and Deconstructing Developmental Psychology was shown to provide valuable insights in researching family therapy with children. Based on the analysis, it is argued that paying attention to the social, ideological and cultural context in which family therapy takes place opens up novel ways of conceptualising and researching the process of therapy and allows the exploration of taken-for-granted assumptions about childhood, adulthood, parenthood and the family.
... The literature also contains qualitative analyses of a single, representative session (Sutherland & Strong, 2011), of a few sessions (Beck et al., 2006;Lambert et al., 2012;Moran et al., 2005), and of in-session moments that clients identified as especially good or poor (e.g., Bowman & Fine, 2000;Helmeke & Sprenkle, 2000;Strickland-Clark, Campbell, & Dallos, 2000). Qualitative studies have used methods based on grounded theory, conversation analysis (Diorinou & Tseliou, 2014;Sutherland & Strong, 2011), ethnography (Kuehl et al., 1990), and constant comparison (Friedlander, Heatherington, & Marrs, 2000;Higham et al., 2012;Lambert et al., 2012). ...
Objective:
In this article we describe and assess the state of the science on systemic psychotherapies. In the quarter century since the first issue of Psychotherapy Research was published, considerable progress has been made. There is an increasingly solid evidence base for systemic treatments, which includes a wide range of approaches to working conjointly with couples and families. Moreover, there are exciting new developments that hold promise for explicating the dynamic processes of therapeutic change in couple and family systems.
Method:
We begin by explaining how we view "systemic therapies" as different from individual approaches and then summarize what we have learned in the past 25 years about this set of treatments, how we have learned it, and what we have yet to learn.
Results and conclusions:
We consider current trends in research on outcomes and change process mechanisms, and end with speculations about what lies ahead in the interrelated domains of systemic research and practice.
... The first studies on family interventions to incorporate satisfaction ratings focused exclusively on feedback from parents. Traditional family therapy seemed to treat children as the objects of treatment rather than its participants (Strickland-Clark et al., 2000). Adolescents and children were viewed as incapable of forming coherent opinions, in part because of their limited language or communication skills. ...
Assessing clients' satisfaction with family therapy interventions has important practical and theoretical implications. This article presents findings on client satisfaction after participating in functional family therapy ( FFT ), which addresses youths at risk of delinquency behaviour and communication problems in the family. Qualitative interviews and quantitative research methods are employed to compare programme perceptions with standardized therapeutic outcomes. The data include a parent or guardian interview, a youth interview, a services tracking form and the initial and discharge strengths and needs assessment ( SNA ). We observed high levels of satisfaction with FFT , yet satisfaction with family therapy and therapists was higher among parents. Parents uniformly indicated satisfaction on six Likert scale items while the youths were satisfied only on one. We found five significant differences between the parents' and youths' responses. The parents reported greater trust in therapists, more engagement in family therapy and more positive perception of changes in family dynamics following the intervention. The two scales, satisfaction with the programme and satisfaction with the therapists, were correlated only for parents. However, both scales were correlated with some items on our outcome variable: the changes in the SNA , for parents and young people. We assessed predictors of satisfaction and found that satisfaction with therapy was inversely related to the number of sessions for youth. For parents, the only common predictor of both satisfaction with the therapist and satisfaction with the programme were the changes on the caregivers' strengths scale. The answers to the open‐ended questions indicated that, although both parents and adolescents valued the improvements in communication patterns, the youth seemed to be especially attuned to changes in this area. Researchers should continue assessing satisfaction with family therapy and study the relationship between satisfaction and the intervention's outcomes. Our findings suggest also the importance of including youth in assessing satisfaction.
Practitioner points
Assessing feedback from both, parents and youth, during and after an intervention can assist in providing more effective treatment.
Youth might benefit from a shorter therapy and those who are mandated should be given more voice in an intervention.
The strengths and needs assessment is a clinical tool that is useful in evaluating the intervention's outcomes.
Functional family therapy improves communication skills among family members.
... By blaming the child and fostering an environment that encourages children to view themselves as problematic, parents may inhibit engagement by the child. Indeed, research shows that children feel that the presence of their parents inhibits their conversational contributions, as they are concerned about family reactions (Strickland-Clark et al., 2000). It may be good practice to offer therapeutic time alone with the child to elicit those opinions in a safer environment. ...
This article reports research on family therapy interactions. The research uses discourse analysis to explore the ways in which parents construct their reasons for requiring family therapy, the outcomes they desire from it and orientations to their progress. The analysis suggests that parents often position their child as the problem and this is something that is rarely challenged or questioned by the child. Parents express a desired outcome of ‘fixing’ the child and highlight this as what they believe the purpose of family therapy to be. During therapy they emphasize their progression and consider improvements in family functioning. By understanding parental perceptions we can move research forward in understanding engagement in therapy and attrition, and integrate guidelines on service improvements with what parents feel is beneficial.
Practitioner points
Parents manage their presence in family therapy in many ways and typically position the child as the reason for their attendance.
Offering the child some time alone with the therapist has potential to uncover the child's perspectives on goals and outcomes which may be inhibited by parental presence.
Anticipating that the child may be described in derogatory or negative ways at the start can help the therapist to reframe the problem in more helpful ways.
... One starting point is that it might be valuable to build on the obvious importance of sibling relationships and sometimes see siblings together, or at least take care to include them in the therapeutic formulation. Previous research on children's experience of family therapy (Strickland-Clark, Campbell, & Dallos, 2000), for example, shows that children often feel safer, less vulnerable and less a focus of blame if their siblings attend sessions with them. ...
This article examines the impact of divorce on relationships between siblings. It is argued that despite the massive number of children who go through this experience few studies have invited children to talk about their experiences. An exploratory qualitative study is reported with eight young women who talk about the effects of the divorce of their parents on their relationships with their siblings. The study employed a form of interpretative theme analysis and used sociograms to illustrate perceived changes in family and sibling relationships. Three metathemes emerged: changes over time, emotional impacts of the divorce and systemic processes. Overall, the findings indicated that siblings experienced increased closeness as a result of the shared experience of going through the divorce of their parents together. The young women also reported turning to each other for support as a result of the emotional unavailability of their parents during the divorce. Some implications for clinical practice are discussed, especially working together with siblings as well as with their families.
... Many of the children did not want to go at first, and the authors suggest that this may be accounted for by children's unfamiliarity with therapy and therapists' inability fully to communicate with children. Strickland-Clark et al. (2000) interviewed five children between the ages of 11 and 17 on two occasions following family therapy sessions, without their parents' presence. In addition, video replay was used to compare the children's ideas about specific moments with the ideas of their therapists. ...
In an exploratory study a number of children were interviewed some time after family therapy. Their responses were analysed using grounded theory methodology. Outcomes indicate that for children, family therapy is potentially a complex arena in which ambiguities and ambivalences are present. The children’s position in the therapeutic session is discussed in terms of their role in the ‘therapeutic circle’.
... The same repertoire of research techniques is yet to be developed to ensure that children and young people are being given the best possible chance of contributing to service evaluation. Evidence of children's desire to be part of therapy (Smith et al., 1996; Strickland-Clark et al., 2000) suggests that children's reactions to therapy can be influenced by their attachment style. In families where there are insecure attachments for example, children can feel constrained to speak more freely because of fears of what the consequences might be and the discomfort in exposing painful or difficult feelings. ...
Children’s perspectives have rarely been explored in relation to the help they receive towards their emotional and mental well-being (Hill et al 1995, Gordon and Grant 1997) The prevalence and upward trends of mental health problems in childhood together with findings that young people with such difficulties are reluctant to make use of specialist services or quickly cease contact ( Mental Health Foundation 1999; Audit Commission 1999; Richardson & Joughin 2000) indicates the importance of developing appropriate sources of help that are experienced as useful and relevant and therefore going to be used effectively. In order to do that methods of consulting with children and young people need to be developed that are appropriate, effective and methodologically robust.
... In interviews following a series of family therapy sessions, children expressed a desire to be active and to be included (Stith et al. 1996 ). Clark et al. (2000) interviewed children about their experiences of family therapy and found they needed more support. The children appreciated being listened to and not being judged, but it was sometimes difficult for them when the adults reacted to what the children would say, or when the conversation concerned only the parents. ...
The first meeting in psychotherapeutic and psychosocial work, has a big impact on the continuation. It is a less explored
research field. Children’s “voices” tend to come in the back-ground in family therapy and other settings. In a project at
CAP (Child and Adolescent Psychiatry) the children’s views were collected in interviews with parents and therapists present.
The grounded theory analysis process was used. The children addressed the importance of the therapist’s actions and positions
in helping them to be able to communicate and to be in a dialogue. To be accepted and allowed to express feelings was important,
and so was how the therapist managed to adjust to each person in the room and give space for various perspectives.
... In community psychology, the same concern about stigmatization occurs when children and their families are determined to be ''at risk'' and are targeted for prevention programs. For children, stigma and the associated social exclusion may mean being denied participation in recreational programs, frequent suspensions from school, being treated as side-participants in family therapy, or not being connected with services because of parental ambivalence or avoidance (Cederborg 1997; Richardson 2001; Strickland-Clark et al. 2000; Tuchman 1996). Agency and power in child/adult relationships. ...
This paper explores the use of participatory action research (PAR) with children diagnosed with mental health issues. We argue that critiques from the sociology of childhood are useful for guiding PAR with children. First, we describe and critique values and assumptions that underlie research and practice with children who experience mental health issues. Second, we outline key qualities of the sociology of childhood, discuss their implications for PAR with children diagnosed with mental health issues, and touch on ethical issues. Five themes are explored: (a) values, (b) ontology/epistemology, (c) views about children, (d) agency/power in children's relationships with adults, and (e) intervention/change focus. We conclude by encouraging community psychologists to consider PAR with children diagnosed with mental health issues.
This study explores the views and experiences of young people, adopted and in the care of a local authority who had received a therapeutic intervention from an NHS Attachment and Trauma Specialist Agency. Three children were interviewed, aged between 10 and 14 years, using semi‐structured interviews. The interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). The analysis of the results met with the findings in the literature that young people want to have access to non‐judgmental therapy which both meets their needs and is creative. Recommendations for clinicians include giving adequate preparatory information and ensuring on‐going collaboration with young people receiving therapeutic interventions through the use of on‐going feedback about what works for them.
Practitioner points
Practitioners should consider carefully how young people in public care are 'invited' to therapy, and give adequate pre‐session information to help to reduce anxiety.
Children and young people in public care engaging in therapy prefer a practitioner style which is creative, playful and enjoyable.
A systemic framework can be integrated with attachment and trauma focused models of intervention.
In family treatment, building and evaluating multiple alliances with family members is complex. We investigated the occurrence and development of discrepancies between therapists' alliances with different family members, and therapists’ evaluation of these multiple alliances and discrepancies. Participants were 92 parents and 61 children and adolescents from 61 families receiving home‐based family treatment. Family members, therapists, and observers reported early and mid‐treatment alliance. We found significant discrepancies, with strongest alliances with mothers, followed by fathers, and then youths. Differences became smaller during treatment. Therapist‐reports yielded similar discrepancies as compared to client self‐reports and observer‐reports. At T1, the correlation between therapist‐ and client self‐reports was moderate and significant for alliances with mothers, but insignificant for alliances with fathers and youths. At T2, these correlations were large for alliances with mothers and fathers, but not for youths. Our findings demonstrate that therapists have stronger alliances and are more congruent in their alliance perspective with parents (especially mothers) versus youths.
Practitioner points
• Our findings demonstrate that in family treatment, differences in alliances between therapists and family members are the rule rather than the exception
• In family treatment therapists tend to have stronger alliances and be more congruent in their alliance perspective with parents (especially mothers) than with children and adolescents
• Awareness that building alliances with some family members demands an extra effort might enhance the process of building and balancing multiple alliances in family treatment
• Therapists could seek family members’ feedback on the alliance to gain a more shared perspective, paying particular attention to young people’s feedback
Despite the considerable potential of qualitative approaches for studying the systemic and constructionist therapy process due to shared theoretical and epistemological premises, to date there is lack of a comprehensive qualitative synthesis of how change process is experienced and conceptualized by clients and therapists. To address this evidence gap, we performed a systematic meta-synthesis review of 30 studies reporting clients' and therapists' retrospective narratives of change process across systemic and constructionist models and across a range of client configurations, including individuals, couples, families, and groups. The studies were identified following a systematic search in PsycINFO and MEDLINE resulting in 2,977 articles, which were screened against eligibility criteria. Thematic analysis led to the identification of four main themes: (1) navigating through differences, (2) toward nonpathologizing construction of problems, (3) navigating through power imbalances, and (4) toward new and trusting ways of relating. Findings illustrate the multifaceted aspects of systemic and constructionist change process, the importance for their reflexive appraisal, and the need for further research contributing to the understanding of the challenges inherent in the systemic and constructionist therapeutic context.
Despite the emphasis of systemic and constructionist approaches on discourse and interaction, to date there has been no comprehensive overview of how change process is performed within in-session therapeutic dialogue. In this paper, we present a qualitative meta-synthesis of 35 articles reporting systemic and constructionist therapy process data from naturally occurring therapeutic dialogue. The studies were selected following the screening against eligibility criteria of a total sample of 2,977 studies identified through a systematic search of PsycINFO and MEDLINE databases. Thematic analysis of the 35 studies' findings identified four main themes depicting change process performance: (a) shifting to a relational perspective, (b) shifting to non-pathologizing therapeutic dialogue, (c) moving-forward dialogue, and (d) the dialogic interplay of power. Findings highlight the interactional and discursive matrix within which systemic and constructionist change process occurs. Findings illuminate the value of qualitative research studies sampling naturally occurring therapeutic discourse in bringing this matrix forth, particularly when utilizing discursive methodologies like conversation or discourse analysis.
Child and adolescent mental health services (CAMHS) have enjoyed
something of a renaissance in recent years after decades of under-investment,
rising demand and increasing waiting times for children and young people
suffering psychological problems. At the same time social work has witnessed
the continuing erosion of its original practice principles which employed a
psychosocial framework to understand human difficulties resulting from a
combination of external stressors and internal conflict.
The social work literature has recorded and debated the demise of the
therapeutic dimension to social work practice while expressing a mixture
of regret and ambivalence about its replacement with a care management or
administrative model of practice (Adams et al. 2002; Payne 1997; Stepney
and Ford 2000; Trevithick 2000).
Debates about the role of social work have peppered the modern history
of the profession but in the 1980s sharply focused on the reaction to the
Barclay Report [AQ] and CCETSW paper 31 (CCETSW 1989). These
documents provided social work educators and theorists with evidence
to advance their arguments for social work to be part of the progressive
movement which embraced community activism, resistance to oppressive
state processes and solidarity with marginalised groups in society; or part
of a residual welfare system, resisting any identification with social justice
and seeking to maintain citizens within the limits of minimalist welfare
provision (Corrigan and Leonard 1978; Dominelli 1988; Egan 1981;
Howe, D. 1999; Jordan 1990).
The development of ‘youth-friendly’ services has become a priority across a wide range of health-care contexts. However, relatively few studies have specifically examined users’ experiences of, and preferences for, child and adolescent mental health care. The current study investigated young service users’ views of outpatient and community mental health clinics in Sweden, based on two data sources. First, focus group interviews were conducted with seven children and adolescents (aged 10–18 years) to explore both positive and negative experiences of mental health care. Second, written suggestions about specific service improvements were obtained from 106 children and adolescents. Qualitative content analysis revealed three overarching themes: ‘Accessibility’, ‘Being heard and seen’ and ‘Usefulness of sessions’. Young people’s recommendations for improving practice included more convenient appointment times, offered in welcoming settings; opportunities to communicate more openly with clinical staff, enabling sensitive discussion of mental health and wider personal issues; and more structured treatments that offer greater credibility and relevance to young people’s mental health and developmental needs. Young people also discussed being compelled by parents and school professionals to engage in treatment. Attending to young people’s preferences must be a priority in order to overcome ambivalence about session attendance, and enhance treatment participation and outcomes.
p> Ανάμεσα στις βασικές ικανότητες που πρέπει να αναπτύξουν κατά την αρχική εκπαίδευσή τους οι υποψήφιοι εκπαιδευτικοί, είναι η ικανότητα αναγνώρισης και κατανόησης των ιδιαίτερων χαρακτηριστικών των παιδιών μιας τάξης και η ικανότητα επικοινωνίας μαζί τους. Με στόχο την ανάπτυξη των παραπάνω ικανοτήτων μια από τις πιο συνηθισμένες στρατηγικές στις οποίες καλούνται να εξασκηθούν οι υποψήφιοι εκπαιδευτικοί, κατά τη διάρκεια των σπουδών τους, είναι οι ατομικές συνεντεύξεις με παιδιά.
Κατά τη διάρκεια της Α’ φάσης του προγράμματος της Πρακτικής Άσκησης του Τμήματος Επιστημών Προσχολικής Αγωγής και Εκπαίδευσης του Αριστοτέλειου Πανεπιστημίου Θεσσαλονίκης, χρησιμοποιήθηκαν οι ατομικές συνεντεύξεις εκπαιδευτικών-παιδιών ως ένα εργαλείο που μπορεί να δώσει στους υποψήφιους εκπαιδευτικούς τη δυνατότητα να εξοικειωθούν με τεχνικές διατύπωσης ερωτήσεων και επικοινωνίας με μικρά παιδιά και να προσεγγίσουν τον τρόπο σκέψης αυτής της ηλικίας.
Μετά τη συνέντευξη με ένα παιδί της δικής τους επιλογής, οι φοιτήτριες κλήθηκαν να απαντήσουν σε ερωτήσεις που αφορούσαν το σχεδιασμό και την υλοποίηση των ατομικών συνεντεύξεων με στόχο τη διερεύνηση των απόψεών τους για το συγκεκριμένο εργαλείο ως «μέσο γνωριμίας» με τα παιδιά. Η ανάλυση των απαντήσεων 114 φοιτητριών δίνει χρήσιμες πληροφορίες για τις αντιλήψεις των φοιτητών σχετικά με τα χαρακτηριστικά και τις δυνατότητες των παιδιών της προσχολικής ηλικίας και τη χρησιμότητα, ή μη της ατομικής συνέντευξης ως διδακτικό εργαλείο. Τα αποτελέσματα έδειξαν ότι η συνέντευξη με τα παιδιά μπορεί να αποτελέσει μια αποτελεσματική στρατηγική κατά την αρχική εκπαίδευση των εκπαιδευτικών, για την ευαισθητοποίηση και τη γνωριμία τους με τα παιδιά της προσχολικής ηλικίας.</p
This article describes research that sought to hear the views of services users concerning their experience of therapy at the Family Trauma Centre, a specialist CAMHS service in Belfast.
This article reports the piloting of an approach to apply the principles of child involvement to service experience research. The approach aimed to systematically explore the service concerns of children who had received mental health care. Eleven children who had previously attended mental health services took part in focus groups to discuss their experience. Thematic content analysis of transcribed interviews revealed 13 themes that potentially could help to identify children's key concerns and clarify the notion of child-centred care. The themes suggested the potential importance of children's expectations about therapy, and their concerns relating to the process, content and outcome may be important to their experience of care. The possible implications for child-centred clinical practice and service provision are discussed.
This paper draws on a study that asked twenty family users about their first session of family therapy. Analyses of the interviews indicated that families entered therapy with a pre-existent knowledge about therapy, which did not always chime with those of professionals and which positioned speakers in ways which governed their expectations and perceptions of therapy. This paper, therefore, is concerned with the acquisition and deployment of knowledge: specifically, the knowledge involved in being a user of family therapy. Three key discourses were identified through this analysis: medical, counselling and consumerist. We aim to illustrate how these discourses served as a resource for members of the family in constructing therapists, therapy and themselves in relation to their experience. The examination of the rhetorical, ideological and practical effects of the positions chosen and the objects constructed, in terms of how speakers wanted to present themselves, with what enhanced or diminished status as patients, shows users actively engaging with the power of therapeutic institutions. Users’ accounts suggest that while most speakers felt anxious about the prospect of therapy, there were clear differences in overall satisfaction/dissatisfaction with the experience according to the synchrony between speakers’ construction of the therapist, and themselves as client/patients. Those who seemed to take a traditional view of therapy within a medical discourse valued therapists who offered diagnosis and a cure; those who sought and experienced a counselling relationship with the therapist found their experience to be constructive in terms of enhanced self-knowledge. We believe that the research findings discussed in this paper have implications for family therapists in accommodating to parental and child positions to maximise the effectiveness of therapy and so minimise drop-out.
Purpose – The aim of this study was to examine the retrospective accounts of young adults who were diagnosed with ADHD in childhood to explore how children diagnosed with ADHD learn about and experience their diagnoses.
Methodology – Ten 18–22 year-olds who were diagnosed with ADHD in childhood participated in semi-structured, in-depth interviews. The interviews were transcribed verbatim, coded, and emergent themes were identified.
Findings – Data analysis revealed that children often experience both aspects of stigma and empowerment as they learn about and make sense of their diagnoses. The data suggest that parents, who often act as mediators between the medical community and their children, delivering and explaining diagnoses to their children, can influence this process greatly. Parents can help children utilize their diagnoses to develop coping strategies for their disorder, or exacerbate stigma by withholding information about diagnoses. Participants suggested that parents should talk openly about diagnoses with children and offer coping strategies to employ.
Research limitations – Findings are based on retrospective accounts, and the participants' views are not intended to be representative of the views of all children with ADHD. A goal of future research is to expand this study to other pools of participants, including children.
Practical implications – The findings can inform the delivery and management of children's ADHD diagnoses.
Originality/value – The current study adds to research on the sociology of diagnosis and medicalization of mental health by examining the experiences of children diagnosed with ADHD.
Adopted and looked after children are often excluded from service-user involvement. The purpose of the study discussed here by Julie Davies, John Wright, Susan Drake and Jennifer Bunting was, therefore, to develop methodologies to facilitate the inclusion of junior-school-aged children to reflect on their experience of participating in psychological therapy. Exclusively recruiting this group enabled us to develop age-specific techniques. The clinical implications for therapeutic practice and an effective methodology to ascertain children's perceptions of therapy are discussed. The overarching message is that children with disrupted attachments can be engaged in reflective discussions about mental health services when a methodology is developed specifically for them. This allows us to view services 'through the eyes' of children (Department of Health, 2004a).
This article reports on a follow-up study exploring the use of play-based evaluation methods to facilitate children's views of therapy. The development and piloting of these techniques, with 12 children in the author's own practice, was previously reported in this journal. It was argued that play-based evaluation methods reduce the power imbalance inherent in adult researcher/interviewer-child relationships and provide children with meaningful ways to share their views. In this article, follow-up research into play-based evaluations with 20 children and 7 different play therapists is drawn upon to explore in greater depth the strengths and weaknesses of these techniques. The study shows that play-based evaluation techniques are important and flexible methods for facilitating children's views of child therapy. It is argued that those play therapists who incorporate their therapeutic skills effectively, maintain flexibility and sensitively attune to the child during the evaluation session, enable the child to explore their views most fully.
Studies of users' views of family therapy have rarely explored the means by which children construct their experiences. Family interviews after a first session of therapy included thirteen children aged 8 to 15 years. An analysis of the transcripts demonstrated that, like adults, children draw on forms of explanation generated by acknowledged experts. They used discourses of counselling, therapy, consumerism and education to construct and assess their experiences. The ages of the children affected the construction and evaluation of therapy and the positions taken up in relation to adults. Older children demonstrated more independence from parents. Like adults, the children adopted a variety of stakes, their sophistication increasing with age, suggesting a developmental path towards full membership of adult discursive communities. Recognition that children are active in construing therapy should enhance therapists' insights and facilitate positive therapeutic relationships.
This article discusses the relationship between family support and family therapy and the historical ambivalence between them. Decisions on what form of help to offer families based on effectiveness, efficiency and acceptability are therefore crucial. A review of the characteristics and measures of effectiveness is used to articulate the similarities in both interventions. By illustrating the false dichotomy between them, practitioners in both modes can learn from each other to benefit families.
Service-user involvement is an essential component of mental health service provision. This review aims to synthesise literature that has attempted to elicit children's experiences of mental health services with particular reference to looked-after children. The review is limited to qualitative research with study inclusion based on a synthesis of good quality criteria. Identification of gaps in the literature, directions for further research and implications for service developments are discussed.
This paper provides a review of effective methods for interviewing young and vulnerable groups of children and the influence of their voices on decision-making from the English-speaking literature. Very few studies are designed to address questions of effectiveness. Of those that do, there is evidence to suggest that interviews with young children are enhanced by the use of activity-and computer-based techniques. Quite young children can participate successfully in interviews though their responses are affected by question format. Age, gender and family circumstances will also be an influence. Descriptive-analytical studies in the family, educare and social welfare context suggest that a range of multi-method techniques is being employed to access children's views and that these may be beginning to influence decision-making. Not all young children are as yet asked for their views though involvement increases with age. The impact these have on policy, however, may be less certain. Children want their views to be listened to and treated with genuine consideration, nevertheless, and may not necessarily be upset or offended by questions probing sensitive areas. The current emphasis on widening children's opportunities to talk, however, may risk creating a culture in which children are expected to talk. Extending the range of documented themes to include child survival, renegotiation of parenthood or children and violence that better encompass global issues are discussed.
Parents who came with their child to Child and Adolescent Psychiatry (CAP) for the first time were interviewed 1–2weeks afterwards
in the presence of the child and the therapists. In a grounded theory analysis they revealed uncertainty about their role
in the first meeting as well as of future planning. What had been important to them were aspects like communication, sharing
perspectives, and the reformulation of problems.
KeywordsFamily therapy-Parents’ views-Child psychiatry-First interview
Based upon a qualitative metasynthesis of 49 articles centered on clients' experiences of their conjoint couple and family therapy, the investigators constructed a grounded formal theory of Clients' Relational Conceptions of Conjoint Couple and Family Therapy Quality. The theory suggests from pretherapy conceptions to posttherapy reflections, clients' perceptions of conjoint couple and family therapy quality appear to consist of clients' constructed meanings regarding a series of interrelated relationships between clients and their therapists and therapy environments, between clients and themselves, between clients and other family members, and between process and outcome both inside and outside therapy. Within and across these relationships, clients appear to focus on expectations, connections, balance, and change when evaluating the quality of their clinical experiences. Based upon this theory, the investigators recommend that researchers continue to explore this clinical phenomenon and that therapists regularly seek clients' conceptions of quality in therapy.
This paper describes and analyses the views of vulnerable children of eleven years and under on the relevance of services
they received. The two research questions posed were, first, what are effective practices for engaging with vulnerable children;
and, second, how can the voices of vulnerable children be used to influence the development of policy? The first question
was addressed through a systematic review of existing literature on effective strategies for interviewing vulnerable children
and revealed that few studies that focus on interviewing young children are designed to address effectiveness. As yet, not
all young children are asked for their views by those making decisions about their lives, though their involvement increases
with age. The second question was addressed through focus groups and interviews which revealed that children hold many valid
views related to their roles and relationships with service providers and decisions being made concerning their lives. It
was concluded that whilst children’s lived experience of services they receive could contribute to the creation of more democratic
communities in which children and their families participate, it remains to be seen whether the new Green Paper, Every Child Matters (DfES, 2003), increases their sense of autonomy or merely extends the degree to which they are controlled.
Conducted a multidimensional content analysis of 4 expert counselors' (N. Ackerman, M. Bowen, D. Jackson, and C. Whitaker) approaches to family treatment. Data were from the 1969
Hillcrest Families Series (produced by R. Birdwhistell), films of these experts conducting assessment interviews with the same family. The natural language in these interviews reveal that Ss' behaviors both converged and diverged. Although these Ss did not represent separate theoretical schools, the distinctive features in their sessions were consistent with their theoretical emphases. Across interviews, commonalities included (a) the parents as the most active participants; (b) a focus on the parental subsystem; and (c) similar proportions of certain types of counselor responses (e.g., informative directives). A fair proportion of Ss' messages were indirect (addressed to someone other than the target of the communication). Based on these results and an earlier study by the 1st 2 authors (see record
1985-07308-001) of the same interviews, 2 common change factors in family counseling are proposed: disruption of the existing balance of power among family members and education in the nature and strength of family systems. (30 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Results are presented from a study in which 40 therapist-client pairs were asked to record, after each session of psychological therapy, their views concerning the helpful and unhelpful events which took place. On termination they were asked to describe their views of the helpful and unhelpful events in retrospect, and to report on outcome. A total of 1076 events was collected from 399 therapy sessions, and was content analysed using Elliott's Therapeutic Impact Content Analysis System. Results showed that during therapy the types of event most frequently reported by clients were reassurance/relief and problem solution events, whereas therapists reported the clients' gaining of cognitive and affective insight. After termination, both participants reported the importance to the client of personal contact. Many of the differences between the two perspectives were highly significant, although more differences were found when outcome was poor. It is suggested that different aspects of the therapeutic process have a different degree of salience for therapists and clients, in that clients are most interested in gaining a solution to their problems and feeling better, whereas therapists are more concerned with the aetiology of the problem and its transformation through insight. The implications of these differences are discussed.
This study compared the impact of helpful and hindering events, as perceived by 40 clients, in two forms of psychotherapy: an exploratory, relationship-oriented therapy, and a prescriptive, cognitive/behavioural therapy. All clients received eight sessions of each type of treatment in a crossover design. Events were obtained by self-report both during and at the end of each period, and content analysed for type of therapeutic impact by three trained raters. Results showed that during treatment the most commonly occurring helpful impacts across both types of treatments were 'problem solution', 'awareness' and 'reassurance', while the most commonly occurring hindering impact was 'unwanted thoughts'. Similar impacts were reported at the end of each period, with the addition of 'personal contact'. In addition, it was found that 'problem solution' and 'reassurance' impacts were more commonly reported in prescriptive treatment, whereas 'awareness' and 'personal contact' impacts were more prevalent in exploratory treatment. Only the prevalence of 'unwanted thoughts' was correlated (negatively) with outcome. Some possible reasons for the lack of correlation between reported impacts and outcome are suggested.
The relationship between the client and the therapist continues to be regarded as an important aspect of the therapeutic process. This study examined the various aspects of therapeutic alliance and their associations with treatment outcome in family therapy. The inclusion of two or more family members in the therapeutic process introduces complexity into the relation between alliance and outcome. Results of this study corroborate prior research demonstrating an association between alliance and therapeutic outcome. In addition, associations between alliance and outcome were stronger for wives compared to husbands. A more revealing finding was that when wives' alliance scores were higher than husbands' scores, the outcome of therapy was reported to be more positive than when husbands' alliance scores were higher than wives' scores. Future directions for research investigating alliance in marriage and family therapy are discussed.
The lack of empirical knowledge about how young children participate in family therapy talk highlights the question of their participant status in the therapeutic process. The specific question this study addresses is what kind of participant status young children (4-7 years old) acquire in family therapy talk. Time space analyses were compared with word space analyses of children's participation. Participant status was seen partly as the result of ongoing negotiations. The therapist and parents were the subjects acting with respect to the child, who became the object of their actions. From the perspective of the child, this meant that he or she was primarily accorded the status of a nonperson. The findings of this study raise questions about how family therapy theories have been interpreted in clinical work, especially in therapies concerning families whose young children are symptom-bearers.
The reciprocal exchange of information between a therapist and his or her client(s) is considered a key component of systemic therapy. Yet, while feedback is often considered part of the practice of therapy as it happens "in the room," the generation of feedback from clients using a structured research methodology has virtually been ignored. This paper describes client's perceptions of the family therapy experience which emerged from interviews conducted and analyzed using an ehnographic interview methodology. Four primary domains or categories of meaning, emerged from the interviews which are discussed as important areas of feedback for therapists. These include (1) "expectations of therapy," (2) "types of psychos and shrinks," (3) the setting, and (4) individual versus family therapy. These domains highlight areas of interaction between clients and therapists where the potential for unvoiced misunderstanding appears to be high. The presentation of this study is discussed in terms of postmodern anthropology and radical constructivism. These two schools of thought consider the "realities" of the world as more imagined than real. The objective scientist creates or constructs theories out of his fertile imagination only to confuse his-her process of creation with discovery.
"Rewriting Family Scripts" presents an innovative approach to . . . incorporating into family therapy elements of script theory and recent findings in attachment research, including those related to narrative. Developing a new systemic attachment concept, "the secure family base," from which individual members can feel safe enough to explore and improvise new scripts, author John Byng-Hall shows how families can change insecure relationship patterns both during and after therapy. This book presents a comprehensive conceptual framework that illuminates the central issues of family therapy practice.
The 1st part of the book introduces basic elements of script and attachment theory, and discusses issues of continuity, repetition, and change in family relationships. Showing how personal scripts are linked into a system of relationships, the author develops a systemic model to extend ideas about individual attachments to the family as a whole. Toward this end, the main types of family scripts are delineated.
The therapist's role in facilitating the switch from an insecure base to a secure base is explored in greater depth in Parts II and III.
[This book explores] theoretical foundations as well as practical suggestions for clinical practice. This book is intended] for family therapists of all orientations, attachment theorists, family theorists, and other readers interested in understanding improving family dynamics. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
describe how client and therapist can be enlisted as collaborators in the analysis of their own significant therapy events / illustrate how this can be done and what can be learned about the varying perspectives of client, therapist, and observer, using an event from a first session of an interpersonal-dynamic therapy / close with a clinical commentary by the therapist
lay out the rationale for studying significant therapy events in the way that we do as well as the methods we use for identifying, describing, and analyzing events (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Forty-nine coded twenty-minute transcript segments sampled at six-week intervals from the conjoint treatment of eleven families were examined. Coding procedures tapped both participation and affective expression (Emergency, Welfare, and Neutral) of family members and the quantity, direction, and quality of therapists' interventions. The families were assigned to two outcome groups on the basis of change scores in four areas (Overall; Affective Involvement; Affective Communication and Affective Expression) derived from the independent ratings of pre and post-therapy interviews by three judges (73 percent agreement). A two-way analysis of variance applied to the Good and Poor Outcome group coding data indicated an increase in Welfare feelings, a sharp decrease in Neutral speech paralleled by an initial rise then leveling off of Emergency. For any given therapist-family unit, therapist's output remained within a unique range, the level of which rose gradually only in the Good Outcome group. Therapists focused increasingly on only one family member, usually a parent, the parent initially most talkative. A Good Outcome resulted when the father was initially the more vocal parent, a Poor Outcome when mother outtalked father. The Drive-Interpretation ratio decreased as therapy progressed. The initial level of this ratio was positively related to outcome and inversely to drop-out rate.
The distinctive skills of child psychotherapy can be utilized in the development of a form of conjoint family therapy especially applicable to the field of child psychiatry. It is suggested that the engagement of children in the process particularly enhances the specific characteristics and potentialities of this form of treatment.
Although family therapists often include children in therapy sessions, they rarely consider the child's wishes regarding participation or ask children for their impressions of therapy. In this study, 16 children between the ages of 5 and 13 who had participated in at least four family therapy sessions were interviewed to determine their perspectives on the experience. The children made it clear that they wished to be involved in a meaningful way in therapy and that they wanted to come to sessions even when they were not the focus. Feedback from these children is used to suggest ways family therapists might enhance their effectiveness with families with children.
Twenty-two two-parent families with a referred adolescent were seen by 11 male and 11 female trainees in family therapy. Mothers, fathers, adolescents, and therapists were rated for verbal expression in affective, behavioral, and cognitive! attributional modes during the first session. Results clearly point to role and content difference in modes of expression. Of particular importance are differences by role which occured as a function of therapist gender. These differences suggest that therapist gender has an impact on family therapists' and family members' verbalizations in first sessions of family therapy.
The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.
Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.
A 2-year followup study was conducted to determine the efficacy and degree of satisfaction with Milan-style family therapy with families refractory to other treatment interventions. Fourteen families and 5 couples who received Milan-style family therapy participated in the study. Family outcome was found to be improved in 56% of parents and 89% of identified child-patients at followup. Improved self-outcome at followup was reported by 56% of fathers, 67% of mothers, and 78% of identified child-patients. A substantial percentage of fathers (68%) and mothers (59%) reported that at least one family member sought further therapy posttreatment. Factors associated with either parent's positive perception of the treatment in general included the time interval between sessions, experiencing the treatment as brief rather than long, and positive feelings for the group behind the mirror. Mothers who reported liking the treatment reported better family outcome. For mothers, disliking the treatment was related to family members seeking further treatment. The more negative the mothers' and fathers' spontaneous comments about therapy were, the more likely that a family member would seek further alternative psychotherapy. The outcome results are explained in terms of the treatment families' negative reactions to some aspects of the therapist's stance and to the group behind the one-way mirror, as in Milan-style therapy. The importance of modifying Milan-type therapy to foster a positive attitude toward the treatment procedures and the therapist's interventions is discussed.
The unravelling of a treatment paradigm: a follow-up study of the Milan approach to family therapy
- M Marshal
- R Feldman
- J Sigal
Marshal, M., Feldman, R. and Sigal, J. (1989) The unravelling of a treatment paradigm: a follow-up study of the Milan approach to family therapy. Family Process,
28: 457-470.
The voices of children: preadolescent children's experience in family therapy
- S M Stith
- K H Rosen
- E E Mccollum
- J U Colemen
- S A Herman
Stith, S.M., Rosen, K.H., McCollum, E.E., Colemen, J.U. and Herman, S.A. (1996)
The voices of children: preadolescent children's experience in family therapy.
Journal of Marital and Family Therapy, 22: 69-86.
Psychological therapy as viewed by clients and therapists
- S P Llewellyn
Llewellyn, S.P. (1988) Psychological therapy as viewed by clients and therapists.
British Journal of Clinical Psychology, 27: 223-237.
Dimensions of therapeutic alliance and their associations with outcome in family therapy
- W M Pinsof
- D R Catherall
Pinsof, W.M. and Catherall, D.R. (1986) The integrative psychotherapy alliance:
family, couple and individual therapy scales. Journal of Marital and Family Therapy, 12: 132-151. In: W.H. Quinn, D. Dotson and K. Jordan (1997) Dimensions
of therapeutic alliance and their associations with outcome in family therapy.
Psychotherapy Research, 7: 429-438.